Patient information leaflet Royal Surrey County Hospital NHS Foundation Trust Peripherally Inserted Central Catheter (PICC) Intravenous Therapy
What is a PICC? A PICC is a very fine flexible tube measuring 50 60 cm in length. It is placed in a vein in the arm and threaded up into a large vein outside the heart. The PICC is made of silicone or polyurethane with a rounded tip. The PICC can have either 1 or 2 internal tubes called lumens and are defined as single or dual lumen PICCs. The treatment prescribed determines which is used. Why do I need a PICC? You will need a PICC for one of several reasons: The treatment that you require can only be given through a central line such as a PICC The PICC can be used instead of frequently having to have needles placed in your arm which can be painful. You may need treatment at home and this can be managed using a PICC Who will put in my PICC? Your PICC will be put in by a specially trained nurse. It can be done in Chilworth Day Unit or on the ward if you are in hospital. You can eat and drink normally before and after. How long will it take? It usually takes about 10 minutes to actually put the line in but you should allow 3 4 hours for the appointment. This will give time for the nurse to explain everything, get all the equipment together and check the line afterwards. 2
How is my PICC put in? Your skin will be numbed with local anaesthetic either by applying cream to the skin or injecting a small amount of local anaesthetic underneath the surface of the skin. An ultrasound machine will be used to help identify the best vein for the PICC to go into. A needle is put into a vein and a special device is then used to allow the nurse to feed the PICC into the correct place. This should be a painless procedure although some patients may experience some minor discomfort similar to having a blood test done. As the PICC is being gently threaded up the vein you will be asked to turn your head towards the nurse and angle your chin down towards your shoulder. This helps to guide the PICC into the correct position. The PICC will then be secured and covered with a dressing before a chest X-ray may be taken to check the position of the PICC. If an X-ray is not required, it is because we have used a special picture of the activity of your heart (ECG) to confirm that the PICC is in the correct place. Dressing Following insertion, a gauze dressing will be applied to the exit site of the PICC as there can sometimes be a little oozing of blood in the first 24 hours. This will then be redressed with a clear dressing the day after insertion. Problems with PICC insertions Most PICC insertions go smoothly, but occasionally there are problems. Sometimes the shape of the vein can prevent the PICC from being threaded upwards. If this happens the nurse will probably try again using a different vein. If PICC placement is unsuccessful then it may be necessary for you to have another type of line this is called a skin tunnelled line. This would mean coming for a separate appointment on another day. 3
Aftercare Your PICC will need to be flushed with saline and dressed once a week. If you are in hospital, this will be done by the ward nurses. If you go home following the insertion of your PICC this may be done by the District Nurse or at one of your outpatient appointments. Lifestyle You will be able to move your arm normally when the PICC is in place and carry on your normal life as before. It is important however to protect the PICC dressing with the stockinette sleeve provided or with long sleeves when dealing with children or pets. You may bathe or shower but be careful your dressing and line remain dry. Ask your nurse if you require any further advice on how to do this. Swimming is not recommended whilst the PICC is in place. Do not use scissors, razors, nail polish or liquid tape remover near the line. You can continue working if you are medically fit and your doctor is happy for you to do so. It is advisable to avoid heavy manual work or lifting. You can drive as long as you feel fit and able to. What are the risks? Complications are infrequent but do occur and therefore it is essential that you understand and recognise them. Phlebitis inflammation of the vein the PICC is in. Symptoms are redness or swelling above the site of insertion. It is caused by the body s response to a foreign material inside a vein and usually occurs during the first week. To reduce the risk of it occurring you are advised to apply heat, in the form of a heat pad or hot water bottle to the area just above where the PICC goes into the arm. You should do this 4 times a day for about 20 minutes for the first 2-3 days after the PICC has been inserted. 4
You can also do this at any time if you suspect phlebitis, but contact your GP if this does not resolve the problem within 48 hours. Infection redness, discharge at the exit site, shivering and shaking, feeling unwell or high fever especially after flushing. If this happens contact your District Nurse or GP immediately. PICC blockage/leakage the PICC is unable to be flushed and there may be dampness or white powder under the dressing. If this happens whilst you have an infusion running you will need to contact Chilworth Day Unit or Onslow Ward immediately for advice. If you are in between treatments you should contact your District Nurse or GP at the earliest opportunity. It is often possible to repair a blocked or split line. Line displacement - If you notice that the external part of the PICC line is longer, this may indicate that it has moved out of the vein. If this happens whilst you have an infusion running you will need to contact Chilworth Day Unit or Onslow Ward immediately for advice. If you are in between treatments you should contact your District Nurse or GP at the earliest opportunity. It may be necessary to have a chest X-ray to check the position of the line. Thrombosis a small blood clot in the vein. This sounds alarming but is unlikely to cause a serious problem and may be treated by giving medication to dissolve the clot or by removing the PICC. Symptoms are pain, swelling or shoulder pain on the same side as the PICC or shortness of breath. If you experience any of these symptoms contact your District Nurse or GP immediately. Removal Once your treatment is complete your line will be removed. This is a very simple process and takes only a few minutes. Reference Source The Royal Marsden Hospital Manual of Clinical Nursing Procedures 8th Edn Dougherty & Lister Cancerbacup.org.uk Bard Ltd 5
Contact details Oncology Patients Chilworth Day Unit Tel: 01483 406842 Onslow Ward Tel: 01483 406858/9 Non-oncology Patients Please contact your District Nurse or GP. Royal Surrey County Hospital (RSCH) NHS Foundation Trust fully subscribes to the National Patient Safety Agency (NPSA) Being Open best practice framework, November 2010. PALS and Advocacy contact details Contact details of independent advocacy services can be provided by our Patient Advice and Liaison Service (PALS) who are located in far left corner as you enter the main reception area. PALS are also your first point of contact for health related issues, questions or concerns surrounding RSCH patient services. Telephone: 01483 402757 Email: rsc-tr.pals@nhs.net Opening hours: 9.30am 16.00pm, Monday to Friday If you would like information documents in large print, on tape or in another language or form please contact PALS. Review date: February 2017 Author: Donna Chaplin PIN140404 976 Royal Surrey County Hospital NHS Foundation Trust 2014